Ephemeral or Timeless?: The Brontë Sisters

No abstract available

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Analysis and Long-Term Follow-Up of the Surgical Treatment of Children With Craniopharyngioma

Objective: To investigate the relationship between the operative approach, clinical pathological factors, and curative effect of the surgical treatment in the patients with craniopharyngioma; to provide a theoretical basis for determining the prognosis and reducing the recurrence rate during the long-term postoperative follow-up in children. Methods: This was a retrospective analysis of the clinical data of 92 children who underwent surgical treatment in our department from May 2011 to January 2005. Long-term follow-up was performed from 12 months to 8 years. The pterional approach was used in 49 patients, the interhemispheric approach in 20 patients, the corpus callosum approach in 16 patients, and the butterfly approach in 7 patients. Pathological classification was performed by hematoxylin and eosin stain staining of the pathological tissues and evaluated according to the different surgical approaches, MRI calcification status, calcification type, pathological type, whether radiotherapy was performed, postoperative recurrence, and death. Results: For the pterion approach resection, there was near total resection in 46 patients (93.9%) with the lowest recurrence rate. The operative approach and postoperative recurrence rates were compared; the difference was statistically significant (P 0.05). There was not a significant difference between the MRI classification and postoperative recurrence rate (P >0.05). Comparing the degree of tumor calcification with the recurrence rate after operation and the mortality rate, the difference was statistically significant (P 

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Teaching Our Patients and Residents: Time's Limitations and Technology's Answer

No abstract available

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Clinical Characteristics and Treatment of Osteopetrosis Complicated by Osteomyelitis of the Mandible

Abstract: Osteopetrosis represents a heterogeneous group of rare, hereditary bone disorders with variable clinical features, and an increase in bone density. Osteomyelitis of the jaws is a significant complication of osteopetrosis. In this article, a reported patient with osteopetrosis complicated by osteomyelitis of the mandible was examined. The patient was treated with intravenous antibiotic therapy, debridement of necrotic bone and hyperbaric oxygen therapy; in addition, the authors attempted to implant the calcium sulfate and vancomycin to reconstruct the bone defect. The patient demonstrated satisfactory healing, and no recurrence of osteomyelitis was observed during the 6-month follow-up period. The treatment of osteopetrosis complicated by osteomyelitis of the mandible is difficult. The treatment of osteopetrosis complicated by osteomyelitis is controversial. The authors recommend the following sequential treatment of osteopetrosis complicated by osteomyelitis of the mandible: systemic antibiotic therapy and hyperbaric oxygen therapy before and after surgery; debridement of the necrotic bone; sufficient periosteal coverage and adequate soft tissue to cover the wound; implantation with calcium sulfate and vancomycin to reconstruct the bone defect as much as possible, which may be helpful in treating the disease.

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The Effect of Mandibulectomy and Mandibulotomy on Cochlear Function

Abstract: Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4 kHz (P 

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A New Approach to the Use of Osseointegrated Implants in Palate Obturator

Abstract: Osseointegrated implants are regularly used for retention and stability of maxillofacial prosthesis, especially in palatal obturator with large defects and few remaining teeth. In these cases, loads that tissues receive from a prosthesis can cause bone resorption and thus enlarge the defect. Implants may help redistribute the loads on the perimplant bone crest and avoid exacerbating the defect. The authors present a case in which the palatal defect has increased overtime. After placement of a sealing prosthesis with implants, bone and mucosal tissues stability around the defect it is observed during 1 year of follow-up.

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Osteosarcoma of the Mandible: A Site-Specific Study on Survival and Prognostic Factors

Osteosarcoma of head and neck is a rare condition comprising of

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Review of “The Roles of Vascular Endothelial Growth Factor in Bone Repair and Regeneration” by Hu K, Olsen B in Bone 91: 30–38, 2016

No abstract available

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Assessment of Deformational Plagiocephaly Severity and Neonatal Developmental Delay

Abstract: Deformational plagiocephaly (DP) in infants has been associated with developmental delay that can last until adolescence. Despite this association and a 5-fold increase in incidence of DP over the past 2 decades, there are currently no guidelines regarding screening for developmental delay or identification of which infants with DP are at the greatest risk of delay. A prospective, nonrandomized study was performed. Infants diagnosed with DP who had no prior intervention were eligible for enrollment. Cranial deformity was measured by cross-cranial measurements using calipers, and developmental delay was measured using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Correlation between cranial deformity and developmental delay was analyzed using a linear regression. Twenty-seven infants, ages 4.0 to 11.0 months (mean = 6.61 months) diagnosed with DP were studied. Developmental delay was observed on the composite language (n = 3 of 27, 11%), and composite motor (n = 5 of 23, 22%) scales, but not the cognitive scale. Severity of cranial deformity did not correlate with scores on any Bayley-III scales (cognitive R2 = 0.058, P = 0.238; composite language R2 = 0.03, P = 0.399; composite motor R2 = 0.0195, P = 0.536). This study demonstrates that severity of cranial deformity cannot be used to predict presence or degree of developmental delay. Craniofacial surgeons should be aware of this risk and consider developmental screening based on clinical suspicion.

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Suspected Acoustic Neuroma Demyelinating Lesions

Abstract: Demyelinating lesions were recognized as a kind of rare central nervous system demyelinating lesion. The diagnosis and differential diagnosis of demyelinating lesions is difficult. Once the diagnosis was delayed or incorrect, it will make a great impact on patients. Demyelinating lesions often involved in young and middle-aged, but this patient was the aged, which is rare.

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Correction of a Long Face: Simultaneous Reduction of the Upper Lip Using a Modified Endonasal Technique and Le Fort I Osteotomy Superior Impaction

Background: Although Le Fort I osteotomy superior impaction during bimaxillary surgery is beneficial for patients with a long face, achieving satisfactory results can be challenging due to the redundant upper lip. However, upper-lip reduction has rarely been performed during or following bimaxillary surgery because of the difficulty in estimating the required amount of cutaneous resection needed and the apparent horizontal scars left behind. Therefore, no simultaneous cutaneous upper-lip reduction with orthognathic surgery has been reported. The authors present successful clinical outcomes using a modified endonasal upper-lip reduction technique performed with orthognathic surgery. Methods: A total of 33 patients underwent simultaneous cutaneous upper-lip reduction with orthognathic surgery. Of those, 15 patients were statistically analyzed. The amount of skin excised was individualized depending on the amount of Le Fort I osteotomy superior impaction and the aesthetic goal. Postoperative changes in upper-lip length were assessed with lateral cephalography. Results: Most patients had satisfactory results without serious complications. Overall lip contours, especially lip height, were greatly improved. The scar was hidden intranasally, aside from inconspicuous scarring in the subalar area. Regarding Le Fort I osteotomy, the amount of superior impaction averaged 3.26 mm (range, 0–6.0). The amount of upper-lip reduction averaged 3.42 mm (range, 3.0–6.0). Upper-lip length decreased from 25.27 ± 0.94 mm preoperatively to 21.22 ± 0.94 mm postoperatively (P 

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Diode Laser Clinical Efficacy and Mini-Invasivity in Surgical Exposure of Impacted Teeth

Abstract: The gold standard to arrange impacted teeth in the dental arch is represented by a surgical approach followed by orthodontic traction force application. In the literature, many surgical approaches are proposed to reach such a scope. The aim of the present study is to demonstrate how laser technique could positively assist surgical approaches. Study population was composed by 16 patients undergoing orthodontic treatment of 20 impacted teeth. In 10 patients (population A) surgical exposure of the impacted teeth was performed using a 980 nm diode laser, while in the other 10 patients (population B), surgical incision was performed using a traditional lancet. Only 3 patients of the population A needed local anesthesia for surgical procedure while the remaining 7 patients reported only faint pain during surgery. Two patients referred postsurgical pain (numerical rating scale average value = 2) and needed to take analgesics. None of the patients showed other postsurgical side effects (bleeding, edema). All population B patients needed infiltrative anesthesia and referred postsurgical pain (numerical rating scale average value >4) treated with analgesics. Moreover, in such population, 4 patients referred lips edema while 4 showed bleeding and 6 needed surgical sutures of soft tissues. The lack of side effects of laser surgical approach to expose impacted teeth must persuade dental practitioners to choose such a clinical approach to closed surgical approach every time it is possible.

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Publication Rates of Studies Presented at the International Society of Craniofacial Surgery Congress

Background: The proportion of presentations achieving publication in a peer-review journal has been suggested to demonstrate the quality of research presented at a conference. No data is available examining the publication rate of research presented at Craniofacial Surgery meetings. Objective: The aim of the study was to examine the publication rate of abstracts presented at the International Society of Craniofacial Surgery Biennial Congresses from 2003 to 2011. Methods: A search was made of the PubMed database for publication of podium presentations of International Society of Craniofacial Surgery Congresses between 2003 and 2011. Results: Thirty-five percent of podium presentations were published in a peer-reviewed journal. Thirty-one percent of presentations were published within 4 years, and the rate of publication decreased 2 years following presentation.

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Post-Levator Aponeurosis Fat Pad

Abstract: The aim of this study was to examine the superoinferior extension of the post-levator aponeurosis fat pad in the upper eyelids of Japanese cadavers. Twenty-six upper eyelids (12 right and 14 left) from 15 Japanese cadavers (6 men and 9 women; average age at death, 82.1 years) were used in this experimental anatomical study. After an orbital exenteration, the tissues were cut sagittally through the center of the orbit, and the superoinferior extension of the post-levator aponerosis fat pad was microscopically examined on the sections. Consequently, the fat pad superiorly reached the myotendinous junction between the levator aponeurosis and the levator palpebrae superioris (LPS) muscle in 17 eyelids with the nonbranching LPS muscle. The fat pad extended to the roots of the superior and inferior branches of the LPS muscle in the other 9 eyelids with the branching LPS muscle. Inferiorly, the fat pad was limited to the conjunctival fornix in 13 eyelids, but reached the tarsal plate in the other 13 eyelids. This study showed anatomical variation in the superoinferior extension of the post-levator aponerosis fat pad in Japanese cadavers.

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Assessment of the Relationship Between Clinicophysiologic and Magnetic Resonance Imaging Findings of the Temporomandibular Disorder Patients

Abstract: Temporomandibular joint disorders (TMJDs) are a complex group of disorders that comprise dysfunctions of the temporomandibular joint (TMJ). In this study, we analyzed the objective and subjective findings of the TMJD patients by using Helkimo anamnesis (Ai) and clinical dysfunction (Di) indices, and tried to document a relation between these findings and magnetic resonance imaging (MRI) results. Ninety-eight patients who were admitted to our clinic were included in the study. The clinical evaluation was performed by using Ai, an 8-question-survey based on the objective symptoms of patients; Di, concluded as the score of 5 objective measurements of physical examination. The morphology of the TMJ was evaluated by MRI, and the findings were analyzed and statistically compared with respect to the Di. The most commonly seen symptoms were noise during mandibular movement (58%), pain around the joint (42.5%), and pain with mandibular movements (40%). Seventeen patients (17.3%) were Di0, 47 (48%) were DiI, 24 (24.5%) were DiII, and 10 (10.2%) were DiIII. Thirty-seven patients (37.8%) had abnormal MRI findings, whereas 61 patients (62.2%) had normal MRI. The most commonly encountered pathology was anterior disc displacement with reduction, which was reported in 15 patients. Increased TMJ Di, which points a more progressed TMJD, was found to be significantly related with the pathological MRI findings (P 

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Bone Marrow Stem Cells and Ear Framework Reconstruction

Background: Repair of total human ear loss or congenital lack of ears is one of the challenging issues in plastic and reconstructive surgery. Objective: The aim of the present study was 3D reconstruction of the human ear with cadaveric ear cartilages seeded with human mesenchymal stem cells. Method: We used cadaveric ear cartilages with preserved perichondrium. The samples were divided into 2 groups: group A (cartilage alone) and group B (cartilage seeded with a mixture of fibrin powder and mesenchymal stem cell [1,000,000 cells/cm3] used and implanted in back of 10 athymic rats). After 12 weeks, the cartilages were removed and shape, size, weight, flexibility, and chondrocyte viability were evaluated. P value  0.05). After staining with hematoxylin and eosin and performing microscopic examination, very few live chondrocytes were found in group A. In group B, size and weight of samples were not changed (P 

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An Ideal Flap Alternative for Closure of Myelomeningocele Defects: Dorsal Intercostal Artery Perforator Flap

Background: Dorsal intercostal artery perforator (DICAP) flap is an ideal flap to be used for posterior trunk defects since it leads to lower donor-site morbidity and shorter operative times, offers easy surgical planning, and uses a reliable and easily identifiable artery. Materials and Methods: The study retrospectively reviewed 52 patients with meningomyelocele defects that were closed with DICAP flap between January 2007 and May 2015. Surgical Technique: Each of the 4th to 12th posterior intercostal arteries can be used as dorsal perforators. The dominant direct cutaneous perforators derive from the 4th, 5th, 6th, 10th, and 11th posterior intercostal arteries. These perforators are located 5 cm medial to the spinous processes of the thoracic vertebrae and can be easily identified. Conclusion: Dorsal intercostal artery perforator flap is a reliable flap alternative for the defects seen in neonates, including myelomeningocele, oncologic resections, burn defects, and radiation burns since it is a thin flap and offers easy surgical planning and shorter operative times.

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Orbitocranial Fibrous Dysplasia: Outcome of Radical Resection and Immediate Reconstruction With Titanium Mesh and Pericranial Flap

Introduction: Fibrous dysplasia (FD) is a non-neoplastic developmental fibro-osseous disease. It represents 2.5% of all bone tumors and 5% to 7% of the benign bone tumors. Orbitocranial region is involved in about 20% of the patients. The main presentations are craniofacial deformity and headache. Loss of vision is the most devastating result of this disease. There is no medical treatment to cure or prevent FD. Radiation therapy is contraindicated. Surgery for the orbitocranial FD is often challenging because of the proximity of neurovascular and ocular structures. Conservative surgical shaving and recontouring is always associated with suboptimal results. Radical excision is potentially curative with no extra morbidity. Orbital hypertelorism, dystopia, or proptosis can be corrected only by radical excision and reconstruction. Aim: The aim of the study was to evaluate the outcome of radical excision of the orbitocranial FD and immediate reconstruction using titanium mesh and pericranial flap. Patients and methods: This prospective study had been conducted on 22 patients with orbitocranial FD with age range from 17 to 52 years (mean 29.5). Radical excision of the lesions was done for all patients through transcranial approach. Immediate reconstruction was achieved using titanium mesh and pericranial flap. Results: Intraoperative dural tears and cerebrospinal fluid leak were reported in 2 patients and repaired with galeal graft. Supraorbital anesthesia occurred in 6 patients. Of these, 2 patients were transient, while the remaining 4 patients were permanent. Wound infection was noticed in 1 patient who improved by medical treatment. Temporary postoperative diplopia occurred in 1 patient and temporary postoperative impaired vision in 1 other patient. In all patients, acceptable or good aesthetic results were observed. No recurrence was detected in our series during the follow-up period that ranged from 24 to 58 months (mean 37.5 months). Conclusion: Radical excision of orbitocranial FD is potentially curative with no extra morbidity. It can achieve good aesthetic and functional results with no recurrence.

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Risk Factors Leading to Free Flap Failure: Analysis From the National Surgical Quality Improvement Program Database

Background: The objective of this study was to identify risk factors for free flap failure among various anatomically based free flap subgroups. Methods: The 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing microvascular free tissue transfer based on current procedural terminology codes. Univariate analysis was performed to identify any association between flap failure and the following factors: age, gender, race, body mass index (BMI), diabetes, smoking, alcohol use, hypertension, intraoperative transfusion, functional health status, American Society of Anesthesiologists class, operative time, and flap location. Factors yielding a significance of P 

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Bruton's Tyrosine Kinase Inhibition Attenuates Liver Damage in a Mouse Warm Ischemia and Reperfusion Model.

Background: Bruton's tyrosine kinase (Btk) is a central player in multiple signaling pathways of lymphoid and myeloid cells. Myeloid cells are crucial early effectors in organ ischemia/reperfusion injury (IRI). BTKB66 is a selective, irreversible inhibitor of Btk. In this study, we hypothesized that Btk inhibition would reduce hepatocellular injury in a murine model of liver warm hepatic ischemia and reperfusion. Methods: First, BTKB66 was tested in in vitro models of LPS-mediated neutrophil and macrophage activation. Then, to assess its efficacy in vivo, BTKB66 was administered orally to mice for seven days prior to subjecting them to 90 minutes of warm hepatic ischemia followed by reperfusion for 6 or 24 hours. Clinical and pathologic features in the livers, including AST, ALT, and a panel of cytokines and chemokines, were examined. Results: BTKB66 potently inhibited LPS-mediated activation of bone-marrow derived neutrophils and macrophages in vitro. It also reduced the severity of IRI as determined by AST and ALT levels, as well as immune cell infiltrates. BTKB66 significantly decreased hepatic markers of sterile inflammation, such as CXCL1, CXCL2, and CXCL10, in parallel with depression of serum markers of the myeloid cell activation, such as CCL5, CCL11, and CXCL5. Conclusion: BTKB66 treatment ameliorated hepatocellular injury in a well-established model of liver partial warm ischemia and in situ reperfusion. These findings confirm that neutrophil recruitment and activation play an essential role in IR-stress, and that targeting Btk activity may provide a useful approach for preventing hepatocellular damage and improving outcomes in liver transplantation. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Shining a light on the murky problem of discarded kidneys.

No abstract available

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Inhibition of T Cell Alloreactivity by Bronchial Epithelium is Impaired in Lung Transplant Recipients, Through Pathways Involving TGF-[beta], IL-10 and HLA-G.

Background: Bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx) results from bronchial epithelial cell (BECs) damages, thought to be orchestrated by T cells primed by antigen-presenting cell (APC) presenting allo-antigens. In this cell cross-talk, BECs are also suspected to play a pivotal immunosuppressive role in T cell alloreactivity. We studied the immunomodulating role of BECs in a human ex-vivo model of allogeneic T cell response, both in healthy subjects and LTx recipients. Methods: BECs from 35 LTx recipients (n=22 stable, n=13 BOS]) and healthy controls (n=25) were cultured as primary cell cultures. Their inhibitory capacities through the involvement of tolerogenic molecules (human leukocyte antigen [HLA]-G, transforming-growth factor [TGF-[beta]], and interleukin [IL]-10) were tested on a mixed lymphocyte reaction between APCs and recipient T cells. Results: Control BECs inhibited T cell alloproliferation by a mean of 53+/-7%. This inhibitory effect of BECs was significantly reduced in the stable LTx group (24+/-8%, p=0.009), but not in the BOS TxP group (53+/-10%, p=0.97). Neutralization of HLA-G, TGF-[beta], and IL-10 partially restored T cell alloproliferation, arguing for their involvement in the immunosuppressive effect of BECs. BECs culture supernatant from stable LTx patients with impaired BEC properties showed a skewed Th2-type secretion profile (high IL-4/IFN-[gamma] ratio). Conclusion: The inhibitory properties of BECs are dysregulated in stable LTx recipients, which could suggest their instrumental role in the initiation of BOS process and potential targeted therapies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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DCD pancreas transplantation meta-analysis: ethical and technical considerations.

No abstract available

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Reply to comment on the article: DCD pancreas transplantation meta-analysis: ethical and technical considerations.

No abstract available

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Ambulatory anesthesia in outer space, is it the future? Improving care and outcome in ambulatory anesthesia.

No abstract available

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An update on pain management for elderly patients undergoing ambulatory surgery.

Purpose of review: The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting. Recent findings: Interest has grown in the possibility of adding adjuncts to a single shot nerve block in order to prolong the local anesthetic effect. The rapid and short-acting local anesthetics for spinal anesthesia are potentially beneficial for day-case surgery in the older population because of shorter duration of the motor block, faster recovery, and less transient neurologic symptoms. Another recent advance is the introduction of intravenous acetaminophen, which can rapidly achieve rapid peak plasma concentration (

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Enhanced recovery after bariatric surgery.

Purpose of review: Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. Recent findings: Many recent trials have evaluated ERAS protocols for bariatric surgery. Most of these protocols originate from modifications within the individual hospital-based conventional perioperative care strategies. Studies demonstrate that 'ERAS based' care requires evidence-based modifications in all preoperative, intraoperative and postoperative phase. Despite a lack of standardization in protocols at present, benefits such as decreased length of hospital stay, rapid patient turnover, shorter operating room times and lower healthcare costs have been well demonstrated repeatedly. Summary: ERAS for bariatric surgery is in its early phase. Nevertheless, literature supports its role in improving perioperative outcomes compared with conventional care in this scenario. Evidence-based protocols, multidisciplinary teamwork and meticulous audit seem to be the key factors for success in ERAS methodology. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Does fluid management affect the occurrence of acute kidney injury?.

Purpose of review: To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients. Recent findings: Uncritical fluid administration may induce renal compartment syndrome and renal venous congestion, which contribute to kidney dysfunction. In more than 5000 randomized surgical or septic patients, goal-directed therapy did not reduce fluid accumulation, acute kidney injury (AKI) development or need for renal replacement therapy. In contrast to synthetic colloids, which increase the risk of AKI, albumin solutions and balanced crystalloids appear well tolerated from a renal standpoint in medical and surgical patients requiring intensive care. However, any clinical benefits compared with 0.9% sodium chloride have not yet been demonstrated. Summary: Although synthetic colloids should be avoided in patients with or at risk of AKI, the renal efficacy of using albumin solutions and/or balanced crystalloids as alternatives to 0.9% sodium chloride in high-risk patients is yet to be confirmed or refuted. Improved goal-directed protocols, which minimize unnecessary fluid administration and reduce potentially harmful effects of fluid overload, need to be developed and tested. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury.

Purpose of review: Acute kidney injury (AKI) remains a serious complication of cardiac surgery. An understanding of the epidemiology and pathophysiology of AKI in cardiac surgery patients is crucial to early recognition and proper management. Recent findings: The article will review the current criteria used for defining AKI and the most recently published incidence rates of AKI in the cardiac surgery population. Variables associated with AKI will be reviewed. The cause of cardiac surgery-associated AKI is multifactorial involving genetic factors as well as insults because of nephrotoxins, ischemia and reperfusion, cardiac dysfunction, venous congestion, inflammation, and oxidative stress. Summary: Investigators should aim to use consistent criteria for defining AKI in future studies. Efforts should be taken to use actual measurements rather than estimated values of baseline serum creatinine whenever possible. Further study of the more recently proposed pathophysiologic factors contributing to cardiac surgery-associated AKI, such as circulating damage-associated molecular patterns, venous congestion, and genetic predisposition, are warranted. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Evaluating metrics of responsiveness using patient-reported outcome measures in chronic rhinosinusitis

Background

Responsiveness, or sensitivity to clinical change, is important when selecting patient-reported outcome measures (PROMs) for research and clinical applications. This study compares responsiveness of PROMs used in chronic rhinosinusitis (CRS) to inform the future development of a highly responsive instrument that accurately portrays CRS patients' symptom experiences.

Methods

Adult CRS patients initiating medical therapy (MT; n = 143) or undergoing endoscopic sinus surgery after failing MT (ESS; n = 123) completed the 22-item Sino-Nasal Outcome Test (SNOT-22), European Position Statement on Rhinosinusitis (EPOS) visual analog scale (VAS), and 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) at baseline and 3 months after treatment. Cohen's d and paired t statistics were used to evaluate the responsiveness of each measure.

Results

Fifty-two (36.4%) subjects and 42 (34.1%) subjects in the MT and ESS groups, respectively, completed baseline and 3-month questionnaires. Subjects with and without 3-month data were similar with respect to baseline demographics, VAS scores, and SNOT-22 scores (p > 0.05). In MT patients, CRS-specific measures, like VAS (d = −0.58, p < 0.01; t = −1.81, p > 0.05) and SNOT-22 (d = −0.70, p < 0.01; t = −3.29, p < 0.05) scores, were more responsive than PROMIS-29 general health domains (p > 0.05 for Cohen's d). In ESS patients, VAS (d = −1.97; t = −9.63, both p < 0.01) and SNOT-22 (d = −1.56; t = −9.99, both p < 0.01) scores were similarly more responsive, although changes in PROMIS-29 domains of Fatigue (d = −0.82, p = 0.01; t = −4.63, p < 0.01), Sleep Disturbance (d = −0.83; t = −3.77, both p < 0.01), and Pain Intensity (d = −1.0; t = −5.67, both p < 0.01) were significant. All 22 individual SNOT-22 items differed significantly after surgery, whereas only 8 items were consistently responsive after MT.

Conclusions

For both MT and ESS patients, CRS-specific PROMs are more responsive to posttreatment clinical changes than general health measures. Still, the SNOT-22 contains items that likely decrease its overall responsiveness. Our findings also indicate that existing PROMs had a greater response to ESS than MT.

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Investigation of chemosensitivity during and after an acute cold

Background

Viral rhinitis (the "common" cold) is a frequent worldwide disease. Olfactory dysfunction is one complication that arises during infection, which in most cases heals up spontaneously upon recovery, whereas in some cases it may persist as a partial or total loss of olfaction. The aim of this prospective study was to investigate the change of other chemosensory systems during a cold.

Methods

Fifty-eight patients (age 18 to 69 years) with an acute cold were compared to a healthy control group (n = 59; age 19 to 63 years). All patients were examined on 2 occasions separated by approximately 4 weeks. Orthonasal, retronasal, gustatory, and trigeminal nasal function were investigated. Furthermore, ratings of real foods, in terms of intensity and pleasantness, were obtained.

Results

Compared to the control group, patients showed a decreased orthonasal (threshold and discrimination) and retronasal function. Furthermore, patients exhibited a decreased sensitivity to salt and a reduced ability to localize menthol, indicating a decreased taste and trigeminal function, respectively. Upon recovery from the infection, orthonasal olfactory and trigeminal sensitivity increased, whereas retronasal sensitivity showed no improvement and salt sensitivity decreased.

Conclusion

This comprehensive study provides empirical evidence that chemosensory impairment is prevalent during a cold, and additionally shows for the first time that chemosensory features associated with food consumption persist postinfection.

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Differences in clinical characteristics and prognosis of sudden low- and high-frequency hearing loss

Objectives/Hypothesis

We compared the clinical characteristics between acute low- and high-frequency hearing loss (LF and HF, respectively) patients, and the efficacy of three different treatment protocols (systemic steroids, intratympanic steroid injection, and combination therapy).

Study Design

Prospective, randomized controlled study.

Methods

A total of 111 patients diagnosed with LF or HF were treated on an outpatient basis. Each group was randomly divided into three equal subgroups based on therapy: oral steroid, intratympanic dexamethasone injection (IT), and combination therapy. Hearing gain was estimated by comparing pre- and post-treatment pure-tone averages. Recovery rate was assessed by Clinical Practice Guideline: Sudden Hearing Loss from the American Academy of Otolaryngology–Head and Neck Surgery.

Results

In comparison of chief complaints, ear fullness and hearing loss were more common in the LF and HF group, respectively (P = .033 and P = .001, respectively). Hearing recovery rates were significantly different between the two groups (i.e., 74.1% [40/54] in the LF group and 45.6% [26/57] in the HF group; P < .001). Oral steroid therapy was most effective in the LF group (P = .017). In the HF group, all three modalities showed similar results, although IT tended to be the most effective (P = .390).

Conclusions

There were differences in chief complaints and treatment responses between LF and HF patients. Although they showed similar partial damage in the cochlea, the pathophysiology of LF and HF may be quite different.

Level of Evidence

1b. Laryngoscope, 2016

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Standardization of double blind placebo controlled food challenge with soy within a multicentre trial

Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a stand...

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FOCUS THEME ISSUE Dec 2016: Photobiology & Photodermatology

Abstract

This current issue of Exp Dermatol inaugurates a new series of "Focus theme issues", each put together by two invited Guest Editors. We start this series off with a focus on "Photobiology & Photodermatology", which primarily covers the inflammatory responses evoked by UV radiation in an intriguing series of contributions that should attract the interest of experts and non-cognoscenti alike. UV-induced immunosuppression fails to occur in Toll-like receptor-4 null (TLR-4 -/-) mice, and the UV-induced apoptosis of macrophages is dependent of TLR-4.

This article is protected by copyright. All rights reserved.

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Endobronchial hamartoma: a rare disease with more common presentation

Hamartomas are the most common benign tumours of the lung with an overall incidence of 0.025–0.32%. They are known to be amalgamation of various tissue types, originating from the embryonic mesoderm. Lung hamartomas typically involve lung parenchyma and only infrequently grows as endobronchial tumours. We present a case of an 80-year-old man who presented to the pulmonary clinic for consultation for breathlessness, recurrent pneumonias and an abnormal radiograph finding. CT scan of the chest showed scattered infiltrates and atelectasis in the left upper lobe. He underwent a diagnostic bronchoscopy that showed a lobulated endobronchial lesion obstructing the left upper lobe bronchus. Brush and forceps biopsies were obtained that were consistent with an endobronchial hamartoma. He was referred to the pulmonology department for endobronchial debulking of the lesion following which he improved clinically during postoperative follow-up.

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Spontaneous penoscrotal bleeding in haemophilia A

Description

A boy aged 3 years presented to the emergency department with sudden onset of painless penoscrotal swelling and ecchymosis of 2 days. There was no history of trauma or similar presentation before this episode. No family history of bleeding disorder was present. On examination, his vitals were stable. Temperature of the scrotum and penis was normal. There was penoscrotal oedema and ecchymosis with loss of scrotal rugosities and normal shape of penis (figure 1). His blood investigations were unremarkable except for prolonged aPTT. Factor assay was performed which came out to be moderate factor VIII deficiency (3.4 IU/dL). The patient was started on intravenous recombinant factor VIII as per World Federation of Haemophilia (WFH) protocol.1 Bleeding was confirmed on high-resolution ultrasonography scan of the scrotum. The patient had an uneventful recovery in a week.

Learning points

Deficiencies of factor VIII and IX...

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Study Calls Into Question Sunscreen in Melanoma Prevention

Sunscreen might not be protective against skin cancer, according to a study that used new moles as a marker of melanoma risk in children, but the newer broad-spectrum products could be more effective.
Medscape Medical News

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Regarding “WhatsApp is an effective tool for obtaining second opinion in oral pathology practice”

Abstract

I would like to congratulate Sarode and coll. on their interesting published paper about the validity of using whatsApp in teledentistry as regards second opinion requests for photomicrographs. However, the study seems somehow biased and its design appears to be unrealistic for several reasons.

First, the authors ignored the problem of compressing photos, which decreases their quality, on WhatsApp simply because twelve 'cases', or photomicrographs of cases, were considered of poor quality.

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A clinicopathological study of the oral lesions of Cowden Disease

Abstract

Background

Cowden disease is a multisystemic cancer predisposition disorder, inherited in an autosomal dominant pattern. Cutaneous and visceral lesions are either malignant tumours or are believed to represent hamartomatous growths Mucocutaneous lesions are present on almost 100% of affected individuals. Nonetheless, some authors consider that the mucocutaneous manifestations of Cowden disease are, in reality, viral warts at distinct steps of evolution. There are only a few studies regarding the oral manifestations of Cowden Disease.

Objectives

To study the oral manifestations of Cowden Disease in nine patients clinically and histopathologically.

Methods

The oral mucosal aspects of nine patients with clinical diagnosis of Cowden Disease were photographed and biopsies were taken from typical lesions.

Results

all biopsied lesions depicted histopathological aspects suggestive of viral warts at distinct steps of development: incipient, well established, and in regression.

Conclusion

Our findings seem to reinforce the poorly understood hypothesis that the mucocutaneous manifestations of Cowden Disease are in reality viral warts. Additional studies are needed to explain why a syndrome caused by the mutation of a tumour suppression gene may cause propensity to warts.

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A risk factor based model for Upper aero-digestive tract cancers in India: predicting and validating the ROC curve

Abstract

Background

A study was conducted to develop and validate a screening model using risk scores to identify individuals at high risk for developing UADT cancers in an Indian population.

Methods

A hospital-based case-control study (n=480) in Pune, India was conducted. We assessed risk factors for UADT cancers by administering a questionnaire through face to face interviews. We developed a risk factor model based on the statistically significant risk factors in multiple logistic regression. A total, single risk score was calculated per individual based on the adjusted odds ratio for each of their risk factors. Standard receiver-operator characteristic curve was plotted for the total score and presence of UADT cancers. The stratification ability of the model was determined using the c- statistic. The optimal criterion value was determined at the point on curve at which the Youden's index was maximal. Confidence intervals were calculated by bootstrapping.

Results

Total risk score for each individual ranged from 0 to 26. Area under the receiver operating characteristic curve (95.8; P<0.001) suggests strong predictive ability. A risk score criterion value of ≤10 produced optimal sensitivity (93.5%), specificity (71.1%), false positive rate (28.8%), false negative rate (6.4%), positive predictive value (74.8%) and negative predictive value (96.6%).

Conclusion

This risk factor based model has the potential of satisfactorily screening and detection of UADT cancers at its early stage in a high risk population like India. The identified at-risk individuals can then be targeted for clinical examination and for focused preventive/treatment measures at the hospital.

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Elucidating the Role of Cyclooxygenase-2 in the Pathogenesis of Oral Lichen Planus – An Immunohistochemical Study with Supportive Histochemical Analysis

Abstract

Objective

Oral lichen planus (OLP) is a chronic, inflammatory disorder that affects the oral mucous membrane. During an inflammatory response, several chemokines and cytokines are released by the cells of the immune system. Activation of MMPs, along with mast cell-derived chymase and tryptase, degrades the basement membrane structural proteins, resulting in basement membrane breaks.

Aim

Investigate the association between the COX-2 expressions, presence of intact or degranulating mast cells within the connective tissue and the extent of basement membrane discontinuity in OLP cases.

Methods

The present study included a total of 50 formalin fixed paraffin embedded specimens (FFPE) of histologically confirmed cases of idiopathic oral lichen planus A retrospective cross sectional analysis was carried out to study the epithelial expression of COX-2 by immunohistochemistry and the use of special stains such as toluidine blue and Periodic Acid Schiff (PAS) to study the mast cell count and basement membrane changes in the oral mucosal tissue respectively.

Results

There was a significant (p = 0.03) association between the COX-2 expressions and mast cell count. As the intensity of COX-2 expression increased from mild to moderate or severe, the number of mast cell count almost doubled.

Conclusion

Interaction between up-regulation of COX-2, mast cell and basement membrane sets a vicious cycle which relates to the chronic nature of the disease. Inhibitors of COX-2 may reduce the inflammatory process preceding the immune dysregulation in OLP.

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Development, Field Testing and Evaluation of the Efficacy of a Hand-held, Portable and Affordable Thermo-coagulator to Prevent Cervical Cancer in Low- and Middle-income Countries

Condition:   Cervical Precancer
Interventions:   Procedure: Thermocoagulation (device);   Procedure: Cryotherapy (device);   Procedure: LEEP (device)
Sponsors:   International Agency for Research on Cancer;   University of North Carolina Global Project Zambia;   Liger Medical Llc
Not yet recruiting - verified November 2016

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Transmembrane protein 88 attenuates liver fibrosis by promoting apoptosis and reversion of activated hepatic stellate cells

Publication date: December 2016
Source:Molecular Immunology, Volume 80
Author(s): Shuang-Peng Cai, Xiao-Yu Cheng, Pei-Jie Chen, Xue-Yin Pan, Tao Xu, Cheng Huang, Xiao-Ming Meng, Jun Li
Transmembrane protein 88 (Tmem88) is a crucial inhibitor for Wnt/β-catenin pathway in the development of myocardial cells. Due to the important role of β-catenin in the activation and proliferation of hepatic stellate cells (HSCs), it is necessary to investigate the function of Tmem88 in HSCs. In this study, we found that Tmem88 expression was decreased in the human liver fibrotic tissues, primary HSCs from fibrotic mice and activated HSC-T6 cells. Functionally, Tmem88 could inhibit HSCs activation and proliferation by blocking Wnt/β-catenin pathway, and promoted the apoptosis of activated HSCs by initiating Bcl-2/Bax/Caspase3 pathway. Moreover, the level of DNA metyltransferase 3a (Dnmt3a) was upregulated in activated HSCs, and siRNA-mediated Dnmt3a silencing led to Tmem88 restoration. These results indicated that Tmem88 played an important role in HSCs activation, proliferation and apoptosis, and Tmem88 expression might be modulated by Dnmt3a.



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Multiple Gastric Erosion Early after a 3 V Lithium Battery (CR2025) Ingestion in an 18-Month-Old Male Patient: Consideration about the Proper Time of Intervention

Introduction. Button battery ingestion is considered an emergency situation in pediatric patients that needs to be managed promptly; otherwise, it may lead to serious and potentially lethal complications, especially when it is impacted in the esophagus. Less attention has been given in cases where the battery passes into the stomach, with guidelines for emergency intervention being based on the presence of symptoms. Case Report. We present a case of an 18-month-old male patient who presented to our emergency department after button battery ingestion. He did not have any symptoms and no pathological findings were encountered during clinical examination. X-ray investigation revealed the presence of the battery in the stomach. The patient was admitted for observation and two hours later he had two episodes of vomiting. He underwent urgent endoscopic removal of the battery where multiple acute gastric mucosal erosion in place of direct contact of the battery's negative pole with the mucosa of the gastric antrum was found. Conclusion. In specific cases the urgent endoscopic intervention for removal of an ingested button battery that is located in the stomach even in asymptomatic patients should be suggested.

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Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

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Effects of mobile phone WeChat services improve adherence to corticosteroid nasal spray treatment for chronic rhinosinusitis after functional endoscopic sinus surgery: a 3-month follow-up study

Abstract

The objective of the study is to investigate the impact of receiving daily WeChat services on one's cell phone on adherence to corticosteroid nasal spray treatment in chronic rhinosinusitis (CRS) patients after functional endoscopic sinus surgery (FESS). This study was a two-arm, randomized, follow-up investigation. Patients with chronic rhinosinusitis with/without nasal polyps following bilateral FESS were randomised to receive, or to not receive, daily WeChat service on their cell phone to take corticosteroid nasal spray treatment. A prescription of budesonide aqueous nasal spray 128 µg bid was given to all the subjects. Then they returned to the clinic after 30, 60, 90 days. The primary study outcome was adherence to nasal spray treatment, whereas secondary outcomes were change in endoscopic findings and SinoNasal Outcome Test-20 (SNOT-20). On the whole, there was a significant inter-group difference in the change of adherence rate (F = 90.88, p = 0.000). The WeChat group had much higher adherence rate than the control group during the follow-up. In terms of postoperative endoscopic scores and SNOT-20, except granulation score, no significant differences were observed between the two randomization groups. WeChat services are already after a short period of observation associated with improved adherence to corticosteroid nasal spray treatment in CRS patients after FESS.

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Tortuous Carotid Artery Extended to Neck Level IIb Mimicking the Metastatic Mass

Specifically in neck level IIb, the expected normal anatomy does not contain any vital structures and consequently it might direct a surgeon to perform rapid surgical dissection of tissues. Therefore aberrant anatomy of the vessels in the patients may be overlooked during neck dissection. Unexpected and potentially devastating injuries can be avoided by respecting the possible aberrant anatomy in any level of the neck. In this case report, a 74-year-old man was presented with laryngeal carcinoma who was treated with laryngectomy and bilateral neck dissection. During the left side neck dissection, tortuous internal carotid artery imitating a metastatic mass was unexpectedly encountered in level IIb. As in this case, surgeons should keep in mind possible aberrant anatomy during the neck dissection and perform surgery staying in surgical principles to be safe for an unforeseen and potential dangerous injuries.

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Corynebacterium propinquum: A Rare Cause of Prosthetic Valve Endocarditis

Nondiphtheria Corynebacterium species are often dismissed as culture contaminants, but they have recently become increasingly recognized as pathologic organisms. We present the case of a 48-year-old male patient on chronic prednisone therapy for rheumatoid arthritis with a history of mitral valve replacement with prosthetic valve. He presented with fever, dizziness, dyspnea on exertion, intermittent chest pain, and palpitations. Transesophageal echocardiography revealed two medium-sized densities along the inner aspect of the sewing ring and one larger density along the atrial surface of the sewing ring consistent with vegetation. Two separate blood cultures grew Corynebacterium propinquum, which were sensitive to ceftriaxone but highly resistant to vancomycin and daptomycin. The patient completed a course of ceftriaxone and repeat TEE study and after 6 weeks demonstrated near complete resolution of the vegetation. To our knowledge, this case represents the first in the literature of Corynebacterium propinquum causing prosthetic valve endocarditis. The ability of these organisms to cause deep-seated systemic infections should be recognized, especially in immune-compromised patients.

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Weighing the Evidence: Bias and Confounding in Epidemiologic Studies in Allergy/Immunology

Publication date: Available online 7 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Elizabeth C. Matsui, Corinne A. Keet




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Endogenous polyclonal anti-IL-1 antibody responses potentiate IL-1 activity during pathogenic inflammation

Publication date: Available online 7 November 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Gunther Spohn, Natalia Arenas-Ramirez, Gregory Bouchaud, Onur Boyman
BackgroundParticular neutralizing monoclonal antibodies to certain cytokines act as agonists in vivo by protection of the cytokine's active site and prolongation of cytokine half-life. While this principle might be useful for targeted immunotherapy, its role in the pathogenesis of inflammation and autoimmunity is unclear.ObjectiveWe sought to determine whether slight, structurally non-relevant modifications of the prototypic pro-inflammatory cytokine interleukin-1β (IL-1β) during an immune response could elicit polyclonal anti-IL-1β antibody responses that modulated IL-1β's in vivo activity.MethodsWe engineered two different IL-1β variants, thereby mimicking the process of cytokine modification occurring during inflammation, and conjugated them to virus-like particles, followed by immunization of mice. The resulting polyclonal anti-IL-1β antibody responses were assessed using in vitro and in vivo assays as well as two relevant (auto-) inflammatory murine models.ResultsWhile antibody responses generated to one variant were potently inhibiting IL-1β, antibody responses induced by the other variant even potentiated the in vivo effects of IL-1β; the latter led to enhanced morbidity in two different IL-1β-mediated mouse models, including a model of inflammatory bowel disease and an inflammatory arthritis model.ConclusionThese data demonstrate that endogenous polyclonal anti-cytokine antibody responses can enhance the cytokine's activity in inflammatory and autoimmune diseases.

Teaser

Capsule summary: Polyclonal anti-cytokine autoantibodies, endogenously generated during an anti-virus-like immune response, can boost, rather than neutralize, pro-inflammatory cytokines thus exacerbating (auto-) inflammatory disorders.


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Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient's symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

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Response to Letter to the Editor re. Hines J, Wilkinson SM, John SM, et al. The Three-Moments of Skin Cream Application: An Evidence-Based Proposal for Use of Skin Creams in the Prevention of Irritant Contact Dermatitis in the Workplace

We respond to the letter [1] from Prof Elsner and colleagues to this journal in which comments are made regarding our recent review, "The Three Moments of Skin Cream Application: An evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace"[2].

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Bronchoscopy and Fogarty Balloon Insertion of Distal Tracheo-Oesophageal Fistula for Oesophageal Atresia Repair With Video Illustration

Background/Purpose:

During repair of esophageal atresia with distal tracheo-esophageal fistula, air leakage through the fistula during mechanical ventilation can cause respiratory demise.

Methods:

From February 2012 until November 2014, all patients with esophageal atresia and distal tracheo-esophageal fistula were subjected to preoperative tracheobronchoscopy. Relatively distal fistulas were cannulated with a Fogarty catheter and blocked by insufflation (video illustration). Relatively proximal distal fistulas were sealed by precise placement of a cuffed ventilation tube.

Results:

Nine of 12 patients received Fogarty balloon placement. The fistula of the remaining 3 patients were sealed by careful tube placement. No complications related to tracheobronchoscopy or Fogarty placement were noted. All procedures were uneventful.

Conclusions:

Preoperative tracheobronchoscopy to evaluate the usefulness of Fogarty balloon insertion or correct tube placement for distal tracheo-esophageal fistula is a safe and easy to perform procedure that can avoid complications in type C esophageal atresia repair.

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